MEDICARE: CDG ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851082200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDG ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	532 HOLICK AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-4339
Country	:	US
Telephone Number	:	770-880-9470
Fax Number	:	404-891-4140

Provider Business Practice Location Address
First Line	:	203 S WATER ST STE 208
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7226
Country	:	US
Telephone Number	:	770-231-4792
Fax Number	:	404-891-4140

Authorized Official
Title or Position	:	OWNER
Name	:	CAMILLE DIONE GRIER
Credential	:	LPC
Telephone Number	:	770-880-9470

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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Directions to “CDG ENTERPRISES, LLC ” Practice Location

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